1. Rheumatoid arthritis – definition, etiology, pathogenesis, clinical presentations/clinical forms, disease course; Diagnosis and differential diagnosis. Treatment. Remission criteria. Prognosis and disability assessment. .

Definition

Chronic autoimmune inflammatory disorder affecting small, medium and large joints

• It’s a SID- systemic inflammatory disease involves other tissues, BV & organs as well as synovial joints.
• Classified by: when 3 or more joints are effected

Etiology

• Genetics: DBR1 and the DR4 alleles of the HLA
• Interactions between these alleles and an unknown infectious agent is thought to trigger the development of rheumatoid arthritis.
• Virus: EBV, parvovirus B19, retrovirus, herpes virus and Rubella virus.

Pathogenesis and Pathanatomy

Complex, involving many types of cells, among others macrophages, T and B cells, fibro- blasts, chondrocytes and dendritic cells

1. Immune system attacks the cells that line your joints within the synovium of the joint → ⬆ vascular permeability, hyperplasia and hypertrophy of the synovial lining cells

• Hypertrophy ⬆ the layers of the lining to 4 – 20 instead of the usual 1 – 2
• There is infiltration of T-lymphocytes - both CD4+ (mainly) and CD8+

2. Activation of B-cells & T-Cells, macrophages and endothelial cells
3. Formation of granulation tissue pannus (Pannus is the extra growth in joints causing pain, swelling and damage to joints, cartilage and other tissues)

• Consists of fibroblasts, small blood vessels, inflammatory cells, collagen fibres

Causes direct tropic damage to cartilage releasing proteolytic enzymes which then destroys cartilage and bones